Revue des maladies respiratoires
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COPD is characterized by airflow limitation that is not fully reversible. Changes in the structure and function of the small airways (less than 2mm diameter) are now recognized to play a major pathophysiological and mechanical role in airflow limitation in COPD. There is, therefore, a need for technology to quantify small airways disease. ⋯ These functional tests are promising solutions for small airways assessment. FOT has the advantage of being a simple method, requiring only the passive cooperation of the subject.
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Intrapulmonary Percussion Ventilation (IPV) was designed to promote airway clearance, to recruit areas of lung and to improve pulmonary gas exchange. Its principle is to administer bursts of small tidal volume at high frequency. This article describes IPV devices, especially the Phasitron(®), which provides a dynamic interface between the pneumatic source of gas and the patient. ⋯ In patients with restrictive pulmonary disease but without ventilatory autonomy, IPV is expected to improve gas exchange. The frequency of percussion will be slower (80-200 cycles/min) but the proximal airway pressure may reach 40cm H(2)O. During the sessions, the frequency may be modified to alternate from a percussive pattern (high frequencies promoting the mobilization of secretions) to a ventilatory pattern (slow frequencies encouraging alveolar ventilation and clearance of secretions).
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Atypical mycobacteria and Aspergillus are opportunistic organisms responsible for severe pulmonary diseases whose development is encouraged by the presence of chronic obstructive pulmonary disease (COPD) and related immunosuppression. ⋯ The development of Aspergillus pulmonary disease may complicate atypical mycobacterial infections and explain a poor response to treatment. Our two case reports suggest that a systematic search should be made for pulmonary aspergillosis during the follow-up of patients with atypical mycobacterial infection.
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In hereditary hemorrhagic telangiectasia the pulmonary arteriovenous malformations frequently lead to complications. In a case of pleural effusion in a patient with known pulmonary arterio-venous malformations, the first diagnosis to consider is a hemothorax even though alternatives such as empyema are possible. ⋯ Pleural empyema is rarely described in the context of hereditary hemorrhagic telangiectasia with pulmonary arteriovenous malformations. In the case of pleural effusion this diagnosis should be considered even though hemothorax is more common.
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Many growth factors involved in tumor angiogenesis are potential targets in thoracic oncology. This work is a review of the literature on the effectiveness of anti-angiogenic treatments in non-small cell lung cancer (NSCLC), small cell lung cancer (SCLC) and malignant pleural mesothelioma (MM). Thirty-four articles and 15 abstracts were identified. ⋯ In conclusion, bevacizumab is the most studied anti-angiogenic agent in thoracic oncology. It is the only approved drug with an indication in first-line and maintenance treatment for stage IV non-squamous NSCLC. The indications for the use of VEGFR-TKI in clinical practice remain to be defined.